Autologous distal femoral condyle graft for patellar reconstruction during TKA in posttraumatic ankylosis: a case report

Introduction Post-traumatic knee ankylosis after patellectomy is uncommon and technically challenging to reconstruct. Loss of the patella shortens the quadriceps moment arm, thereby impairing extensor strength. In active patients, total knee arthroplasty (TKA) alone may leave residual anterior symptoms unresolved. Case presentation A 48-year-old woman presented with severe stiffness and pain after prior patellectomy, with a range of motion (ROM) of 0°–15°. Imaging showed advanced osteoarthritis without obvious collateral deficiency. She underwent TKA combined with implantation of an autologous distal femoral condyle graft as a patellar substitute, with additional suture-anchor reinforcement of the patellar tendon insertion. At 10 months postoperatively, ROM was 0°–120°, the 2011 Knee Society Score (KSS) improved (pain: 40 → 50; function: 13 → 69), and no clinical instability was observed. Discussion Patellar absence reduces extensor efficiency and anterior stability; reconstruction aims to restore extensor continuity and patellofemoral tracking. Ankylosis requires stepwise soft-tissue release and careful joint-line management. Autologous bone graft offers potential for biological incorporation but carries risks of resorption or nonunion. Implant constraint should be minimized while maintaining adequate stability. Conclusion In this patient with post-patellectomy knee ankylosis, TKA combined with autologous patellar reconstruction was feasible and was associated with acceptable short-term clinical stability and functional improvement in the context of combined ankylosis conversion TKA. Long-term durability and any potential advantage over TKA alone require evaluation in larger studies with extended follow-up.